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Neurological Surgery No Shinkei Geka Volume 26, Issue 4 （April 1998）

Neurological Surgery 脳神経外科 26巻4号（1998年4月発行）

Japanese English

研究

圧可変式バルブシャントシステム（Medos Programmable Hakim Valve）と脳室ファイバースコープによるSlit-like Ventricleの治療 The Management of Slit-like Ventricle with the Medos Programmable Hakim Valve and the Ventriculofiberscope 上川秀士 ¹ , 桑村圭一 ¹ , 藤田敦史 ¹ , 太田耕平 ¹ , 江口貴博 ² , 玉木紀彦 ³ Shuji KAMIKAWA ¹ , Keiichi KUWAMURA ¹ , Atsushi FUJITA ¹ , Kohei OHTA ¹ , Takahiro EGUCHI ² , Norihiko TAMAKI ³ ¹兵庫県立淡路病院脳神経外科 ²兵庫県立こども病院脳神経外科 ³神戸大学脳神経外科 ¹Department of Neurosurgery, Hyogo Prefectural Awaji Hospital ²Department of Neurosurgery, Kobe Children's Hospital ³Department of Neurosurgery, Kobe University, School of Medicine キーワード： hydrocephalus , slit-like ventricle , pressure programmable valve , ventriculofiberscope , neuroendoscopy Keyword: hydrocephalus , slit-like ventricle , pressure programmable valve , ventriculofiberscope , neuroendoscopy pp.349-356

発行日 1998年4月10日 Published Date 1998/4/10

DOI https://doi.org/10.11477/mf.1436901557

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Abstract 文献概要
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I．緒言

　先天性水頭症やその他の水頭症に対して，乳幼児期までの早期にシャント手術が行われた場合，高頻度に脳室がslit-like ventricleになることはよく知られている^2,5）．このslit-likeventricleはシャント機能不全の大きな原因のひとつであり，このような患児のシャント再建術はしばしば困難である．これら患児の理想的な治療目標は，シャントからの離脱である．

　一方近年，圧可変式バルブの有効性が報告されている^4,8,9）．中でもHakimらにより開発されたMedos programmable Hakim valve^1）は，電磁石のプログラマーを頭皮上より非侵襲的に用いることにより，年齢や病態に応じてそのバルブ圧を30-200mmH₂Oの間で，極めて多段階（18段階）に変更できるシャントシステムである．したがって，慎重な操作が要求される圧設定の上昇を，少しずつ段階的に安全に行うことが出来る．今回，われわれはこのMedos programmable Hakimvalveと，可動性の少ない硬性内視鏡に代えてグラスファイバーを用いることにより可動性の極めて向上した脳室ファイバースコープ^3,14,15）（軟性内視鏡）を用いて，slit-like ventricleの治療を試みたので報告する．

A slit-like ventricle is one of the serious complications which can occur after a shunting operation. Lowpressure valve systems are usually applied for hydrocephalus during infancy. As a result the shape of theventricle often becomes slit-like after the operation. Many shunt dependent children with slit-like ventricleshave to undergo shunt revisions repeatedly.

From April 1995 to February 1997 the authors used the Medos programmable Hakim valve system for20 hydrocephalic children with slit-like ventricles who had been suffering from multiple shunt problems. The patients' ages at the operation were between 3- 16. Male : Female was 12 : 8. Follow up periods were10-20 months. In 12 of 20 patients the shunt revisions were performed at the time of shunt dysfunctionand the valve pressure levels were able to he set at the highest levels without the appearance of any symp-toms. In this group the size of all the ventricles had become slightly enlarged. In the other 8 patients theoperations were performed for fear of other troubles arising if shunt revisions were neglected. In this group the valve pressure levels were set with reference to the intraoperative ICPs. It took a relatively long period to elevate the valve levels. Shunt dysfunction due to obstruction of the ventricular catheter was seenin one case but the symptom was not so severe and the catheter which had firmly adhered to the choroidplexus was removed endoscopically. In 2 cases of this series the shunt systems were successfully elimin-ated.

The authors report the method and efficacy of their series using the Medos programmable Hakim valvesystem and a newly developed ventriculofiberscope for the slit-like ventricle of children.